Alcohol Withdrawal Protocol

Give Thiamine 100mg IV initially and qd (po, IM/IV), Folate 1mg qd, MVI qd.

Assess current state of withdrawal with CIWA-Ar scoring sheet, attached.

A.CIWA <8 and Low Risk

Monitor CIWA q shift for 2 days

If CIWA >8, go to B.

B.CIWA >8 OR Moderate Risk

Ativan 1-2mg IV or 2-4mg PO x1 stat

Ativan 1mg IV or 2mg PO q4-6h standing

Ativan 1 mg IV or 2mg PO q2h prn

CIWA>8, HR>100 or DBP>100

Hold dose for RR<10, or if patient is

unresponsive to voice(or decreased oximetry, or

other signs of intoxication) -HOLD

dose until no toxicity, resume at lower dose

After first 24 hours, total up 24-hour Ativan

requirement, then split into q4h or q6h standing

dose for the next 24 hours.

Day 3: Begin slow taper of Ativan dose, usually

no more than 15-20% per day. If frequent prn

doses needed, consider stopping taper, raising

dose, achieving stability, resuming at slower rate

C.CIWA> 15 or High Risk

Consider transfer to ICU.

Ativan 2-4mg IV q15 minutes until stable, then use that

dose of Ativan that achieved stability IV q2-3h standing

Hold dose for RR<10, or if pt. is unresponsive to voice (or

decreased oximetry, or other signs of intoxication) -HOLD

dose until no toxicity, resume at lower dose

Goals of treatment:

CIWA<8, HR<100, DBP<100

If this is achieved, total up 24-hour Ativan requirement and

split into q4h or q6h standing dose for the next 24h.

Then begin slow taper of Ativan dose (10-15%/day)

Acknowledgments - Dr. Phyllis Grable

FOR ALLOWING ME TO STEAL PART OF THIS PRESENTATION

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